Sociodemographic characteristics, biological factors, and symptom reporting in midlife women

OBJECTIVE

The purpose of this study is to examine the influence of sociodemographic characteristics, reproductive hormones, and body composition on symptoms reported by generally well midlife women.

DESIGN

The design was a 24-cell, randomly selected quota sample, stratified by four occupations that varied in professional status, two races, and three age groups. One hundred fifty-three women, aged 35 to 69, who worked 20 or more hours a week, who were not on hormone replacement therapy, who were not pregnant, and who did not have a hysterectomy prior to the age of 53 participated in the study. Data were collected at 10 employment sites. Symptoms were assessed by a 22-item symptom index. Serum hormone levels of estradiol and follicle stimulating hormone (FSH) were drawn for each woman, and body composition was assessed by body mass index (BMI).

RESULTS

Chi-square tests showed that significantly more White women than Black women experienced nervous tension, loss of urine, and vaginal dryness. Analyses of variance showed that women experiencing hot flashes had significantly higher FSH levels, lower estradiol levels, and higher BMI than women not experiencing this symptom. Estradiol (odds ratio 0.988) and BMI (odds ratio 1.094) were significant predictors of experiencing hot flashes when entered into a stepwise logistic regression with age and FSH level as covariates.

CONCLUSIONS

Findings suggest that symptoms experienced by midlife women are consistent across races, and that interventions targeting weight reduction may improve hot flashes experienced by midlife women.

Social role quality and psychological well being in employed black and white midlife women

This study examined relationships among job, partner, and parent role quality and psychological well being in midlife black (n = 51) and white (n = 56) women employed in occupations varying by socioeconomic status (SES). Oversampling for black women ensured balanced occupational representation, allowing investigation uncontaminated by SES. Instruments included Baruch and Barnett's Rewards and Concerns Scales, Bradburn Affect Balance Scale, and Center for Epidemiological Studies Depression Scale (CES-D). Better well being scores were reported by black women than whites, and by professionals than non-professionals. However, when race, occupational group, and menopausal status were held constant in a multiple regression analysis, partner role quality was significantly related to both well being scores, parent role quality was related to life satisfaction only, and job role quality was not related to either. Nurses in the workplace can help women identify problematic aspects of their multiple social roles, and facilitate resolution of problems to improve worker health.

The superior colliculus-pretectum mediates the direct effects of light on sleep

Light and dark have immediate effects on sleep and wakefulness in mammals, but the neural mechanisms underlying these effects are poorly understood. Lesions of the visual cortex or the superior colliculus-pretectal area were performed in albino rats to determine retinorecipient areas that mediate the effects of light on behavior, including rapid eye movement sleep triggering by lights-off and redistribution of non-rapid eye movement sleep in short light-dark cycles. Acute responses to changes in light conditions were virtually eliminated by superior colliculus-pretectal area lesions but not by visual cortex lesions. Circadian entrainment was evident in both groups with lesions and in normal controls. Thus, acute light-dark effects on sleep and wakefulness appear to be mediated independently from cortical vision or circadian rhythms.

Women's physical activity patterns: nursing implications

OBJECTIVE

To develop a method of categorizing patterns of physical activity by describing the frequency, intensity, and duration of women's activities.

DESIGN

A 24-cell quota sample stratified by four occupations, two races, and three age groups.

SETTING

Ten employment sites.

PARTICIPANTS

One hundred seventy-six women, ages 35-65 years, who worked 20 or more hours per week at their job, were not currently using hormone replacement therapy, not pregnant, and did not have a hysterectomy before the age of 53.

MAIN OUTCOME MEASURES

An interviewer and self-administered, retrospective occupational, household, and leisure physical activity questionnaire covering the previous 12 months and lifelong activity.

RESULTS

Five patterns of household and leisure physical activity were identified: vigorous, continuous, cumulative, occasional, and inactive. Participation in the vigorous pattern was low, but 34% followed a continuous pattern of leisure activity and 75% followed a continuous pattern of household activity. The number of weekly work hours did not affect the household or leisure pattern.

CONCLUSION

Women may be able to obtain the recommended levels of physical activity from a combination of occupational, household, and leisure activities. Nursing recommendations should guide women to increase their regular leisure physical activity and/or accumulate sessions of moderate-intensity activity by aerobically enhancing daily activities in which they already participate.

Chronic myelogenous leukemia and porphyria cutanea tarda in a patient with limited systemic sclerosis

Systemic sclerosis is uncommonly associated with hematologic malignancies. We report the case of a patient who had chronic myelogenous leukemia 3 years after the CREST variant of systemic sclerosis was diagnosed. She also later had porphyria cutanea tarda. The majority of patients who had hematologic malignancies after the diagnosis of systemic sclerosis proved to have either multiple myeloma or chronic lymphocytic leukemia. Hematologic malignancies may be found in patients with systemic sclerosis (either limited or diffuse).

Interpersonal styles of nurse practitioner students during simulated patient encounters

Evaluation methods are needed to assess nurse practitioners' (NPs') interpersonal skills and provide students with systematic, qualitative feedback. The purpose of this study was to identify characteristics and styles of students' interpersonal behavior from patients' perspectives during simulated encounters. The 29-item Clinical Encounter Q-Set for NPs was generated pertaining to patients' perceptions of their interactions with NP students. Using Q-methodology, simulated patients (SPs) sorted the items immediately after each of their encounters with 45 NP students. Items were rank-ordered along a continuum, ranging from "most like my feelings regarding the encounter" to "least like my feelings." Three interpersonal styles were identified. "Nonjudgmental professionalism" characterized student behavior during the simulation portraying a patient with a sexually transmitted disease. "Competence/confidence" and "empathy/respect" were predominant styles exhibited during the hypertension simulation. The potential value of this method for teaching and evaluation is discussed.

Standardizing faculty evaluation of nurse practitioner students by using simulated patients

Biases related to variations among patients and settings may be reduced by having faculty evaluate the clinical skills of students as they interact with simulated patients. The Student Clinical Performance Scale is a rating scale developed to standardize assessment of videotaped simulated patient encounters with family nurse practitioner students. In a pilot study of faculty interrater reliability, correlation coefficients for independent scoring by faculty pairs using the Student Clinical Performance Scale varied widely among six case studies, and several scenario- and faculty-related factors served as systematic sources of faculty variability. The findings demonstrate the importance of a rigorous approach to developing and testing instruments that guide measurement of clinical competence. The use of simulated patients to evaluate nurse practitioner students provides opportunities to assess a wide range of attributes and holds promise for assessing advanced clinical skills in controlled educational environments.

Attitudes about breast cancer and mammography: racial, income, and educational differences

This study examined the effect of race, income, and education on perceived susceptibility to and control over breast cancer, perceived benefits of and barriers to mammography, and knowledge about breast cancer and mammography use, in addition to determining if predictors for mammography use differed between races. Self-reported mailed survey data were obtained from a convenience sample of 1083 church women (78% Caucasian, 22% African-American) > or = 50 years with no history of breast cancer. ANOVA identified higher susceptibility and lower knowledge scores for African-American women; higher knowledge scores for upper income women of both races; interactions between race and income for benefits and perceived control; and interactions between race and education for barriers. African-American women were more likely to regard fear of radiation as a barrier to mammography (OR = .34; CI = .20, .57) and were more likely to worry about getting breast cancer (OR = .50; CI = .30, .82). Caucasian women were more likely to regard cost as a barrier (OR = 2.36, CI = 1.27, 4.40). For both races, variables predictive of ever having a mammogram were perceived control (White: OR = .69, CI = .54, .88; Black: OR = .50, CI = .38, .92), perceived barriers (White: OR = .88, CI = .83, .95; Black: OR = .75, CI = .64, .88), and knowledge (White: OR = 1.18, CI = 1.04, 1.33; Black: OR = 1.28, CI = 1.02, 1.61). Perceived benefits was predictive only for Caucasians (OR = 1.71, CI = 1.42, 2.06). Racial differences in perceived barriers to mammography and findings about the knowledge differences related to race, income, and education provide direction for health education efforts. The significance of cost factors for Caucasian and low-income women suggest that access barriers remain despite increased use of mammography.

The role of human papillomavirus in the development of pyogenic granulomas

BACKGROUND

Pyogenic granulomas (lobular capillary hemangiomas) and condyloma acuminata share similar locations and risk factors. Human papillomavirus (HPV) types 6 and 11 are commonly associated with condyloma acuminata, but their association with pyogenic granulomas has not been evaluated. The purpose of this study was to determine whether pyogenic granulomas contain evidence of infection with condyloma-producing HPVs.

METHODS

Polymerase chain reaction assays for the E6 and E7 gene sequences of HPV types 6 and 11 and another assay for the E7 region of HPV types 16, 31, 33, 35, 42, and 58 were used to evaluate deoxyribonucleic acid (DNA) extracted from archival pyogenic granuloma biopsies taken from cutaneous and oral epithelium.

RESULTS

Neither cutaneous nor oral pyogenic granulomas contain amplifiable E6 or E7 sequences from any of these viruses.

CONCLUSIONS

Pyogenic granulomas are not caused by HPV 6, 11, 16, 31, 33, 35, 42, or 58. This study does not exclude the possibility that other viruses may be responsible for these tumors.

Lipoxygenase metabolism is required for interleukin-3 dependent proliferation and cell cycle progression of the human M-07e cell line

The cell line M-07e requires either Interleukin-3 (IL-3) or granulocyte-macrophage colony stimulating factor (GM-CSF) for proliferation in vitro. Cells deprived of growth factor for up to 48 hours remain viable but no longer divide. The growth-factor-deprived M-07e cells begin to divide within 48 hours of reexposure to IL-3. Flow cytometric analysis of M-07e cells labeled with hypotonic propidium iodide demonstrates that the percentage of cells undergoing DNA synthesis decreases from 24%, in a log phase population of IL-3 stimulated cells, to 1% when cells are deprived of IL-3 for 24 hours. IL-3-deprived cells accumulate predominantly in a flow cytometry peak representative of G0/G1. DNA synthetic activity, as determined by tritiated thymidine uptake and flow cytometry, resumes between 12 and 18 hours after reexposure to IL-3, reaching a peak of up to 40% by 24 hours and returning to log phase levels by 72 hours. Prior to initiation of DNA synthesis, increases are seen in mRNA levels for five-lipoxygenase-activating protein (FLAP). Following reexposure to IL-3, a rapid time-dependent biosynthesis of leukotriene D4 (LTD4) is induced by M-07e cells. When IL-3 is added in the presence of any of three lipoxygenase inhibitors tested (Piriprost, caffeic acid, nordihydroguiaretic acid) or FLAP inhibitor, MK-886, there is dose-dependent inhibition of the resumption of proliferation and of DNA synthesis. Flow cytometric cell cycle analysis demonstrates that the inhibited cells remain in the G0/G1 population and do not progress through the cell cycle. These results are consistent with our previous observation that an intact lipoxygenase pathway is necessary for hematopoietic growth-factor-stimulated colony formation of normal bone marrow myeloid progenitors and suggest that the induction of a lipoxygenase metabolite or metabolites is necessary for myeloid cells to progress through the cell cycle when stimulated by a hematopoietic growth factor.

Factors influencing effect of mammography screening in a university workplace

The purpose of this study was to examine the relationship between theoretically identified variables and participation in mammography screening in a university workplace. A sample of 1093 women 50 and over returned a questionnaire following the offer of a free workplace breast cancer screening. Anderson's Behavioral Model of Health Services Use identified factors predisposing and enabling women to have mammograms. Predisposing variables included attitudes and experience related to mammography. Enabling variables included income, willingness to pay for mammography, health insurance coverage, and regular source of health care. Comparisons were made among: (i) those who were screened in the workplace, (ii) those who were screened elsewhere, and (iii) those who were not screened. Differences in perceived barriers, perceived benefits, practice of breast self-examination (BSE), and education surfaced. Results indicated, among other things, that women who were older, had no more than 12 years of education, had a family member with breast cancer, and were proficient with breast self-examination were more likely to have participated in the university work-site screening.

Analysis of the retinohypothalamic tract in congenic albino and pigmented rats

To determine whether differences in the retinohypothalamic tract (RHT) were related specifically to albinism, we analyzed the distribution and trajectory of this pathway in congenic F344-c/+ albino and pigmented rats using the inactive subunit of cholera toxin conjugated to horseradish peroxidase as an anterograde tracer. We found that the overall volume of the tract in the albino rats was greater than in the pigmented rats (P < 0.05). We also noted shape differences.

Mammography in older women: one-time and three-year adherence to guidelines

A survey examined self-reported mammography use in a convenience sample of 1,083 women 50 years of age and over. Relationships were examined between ever having mammography; 3-year adherence to mammography guidelines; the predisposing variables of attitudes, knowledge, health history factors, and selected demographics; and the enabling variables of income, health insurance, source of regular medical care, and type of regular physician. Logistic regression analysis for ever having a mammogram identified significant odds ratios (OR) > 1 (p < or = .05) for doctor recommendation for mammography (OR = 14.26), satisfaction with way of living (OR = 2.77), perceived benefits of mammography (OR = 1.35), and knowledge (OR = 1.21). Odds ratios < 1 were found for scaled variables of barriers and control (OR = .81 and .65, respectively). For 3-year adherence, significant odds ratios > 1 were annual Pap tests (OR = 3.36), willingness to pay > or = $50 for mammography (OR = 2.00), benefits (OR = 1.20), and knowledge (OR = 1.18). The odds ratio for control was significant at .85.

Evaluation of the pharmacological selectivity profile of alpha 1 adrenoceptor antagonists at prostatic alpha 1 adrenoceptors: binding, functional and in vivo studies

1. The profile of a range of alpha 1 adrenoceptor antagonists was determined in vitro against cloned human alpha 1A, alpha 1B and alpha 1D adrenoceptors and against noradrenaline-mediated contractions of rat aorta and human prostate. The in vivo profile of compounds was determined in an anaesthetized dog model which allowed the simultaneous assessment of antagonist potency against phenylephrine-mediated increases in blood pressure and prostatic pressure. 2. The quinazoline antagonists, prazosin, doxazosin and alfuzosin displayed high affinity but were non selective for the three cloned human alpha 1 adrenoceptors. Indoramin and SNAP 1069 showed selectivity for alpha 1A and alpha 1B adrenoceptors relative to the alpha 1D subtype. Rec 15/2739, WB 4101, SL 89,0591, (+)- and (-)- tamsulosin showed selectivity for alpha 1A and alpha 1D adrenoceptors relative to the alpha 1B subtype. RS 17053 showed high affinity and selectivity for alpha 1A adrenoceptors (pKi 8.6) relative to alpha 1B (pKi = 7.3) and alpha 1D (pKi = 7.1) subtypes. 3. (+)-Tamsulosin, (-)-tamsulosin, SL 89,0591, Rec 15/2739, SNAP 1069 and RS 17053 appeared to act as competitive antagonists of noradrenaline-mediated contractions of rat aorta yielding pA2 affinity estimates which were similar to binding affinities at cloned human alpha 1D adrenoceptors. The following rank order was obtained: prazosin = (-)-tamsulosin > doxazosin > SL 89,0591 = (+)-tamsulosin > Rec 15/2739 > RS 17053 = SNAP 1069. 4. (-)-Tamsulosin was a very potent, insurmountable antagonist of noradrenaline-mediated contractions of human prostate, yielding an approximate pA2 estimate of 9.8 at 1 nM. The corresponding (+)-enantiomer was 30 fold weaker. SL 89,0591, SNAP 1069 and Rec 15/2739 yielded pA2 estimates which compared well with their alpha 1A binding affinities. The affinity estimate for prazosin on human prostate was lower than the corresponding binding affinity determined at alpha 1A adrenoceptors and RS 17053 was a very weak antagonist on human prostate (pA2 = 6.0) relative to the high affinity (pKi = 8.6) determined at cloned human alpha 1A adrenoceptors. 5. In the anaesthetized dog, in vivo pseudo "pA2' values showed that doxazosin, (+)- and (-)-tamsulosin inhibited phenylephrine-induced increases in prostatic and blood pressure with similar affinity, implying that these agents show little or no selectivity for prostatic responses in this model. SL 89,0591 and SNAP 1069 were moderately selective (3 and 6 fold respectively) for prostatic pressure relative to blood pressure. Rec 15/2739 was a more potent antagonist of phenylephrine-mediated increases in prostatic pressure ("pA2' = 8.74) compared to blood pressure ("pA2' = 7.51). 6. Data in this study suggest that the alpha 1 adrenoceptor mediating noradrenaline-induced contractions of human prostate, whilst having some of the characteristics of an alpha 1A adrenoceptor, cannot be satisfactorily aligned with cloned alpha 1A, alpha 1B or alpha 1D adrenoceptors. In addition, studies in the anaesthetized dog have shown that agents having high affinity and selectivity for prostatic alpha 1 adrenoceptors, particularly over the alpha 1D subtype, appear to inhibit phenylephrine-induced increases in prostatic pressure selectively compared to blood pressure.

Recent mammography in women aged 35 and older: predisposing variables

Early detection through regular mammography screening is the most effective way to decrease mortality from breast cancer. Our purpose in writing this report was to identify factors that influenced women to adhere to mammography guidelines within the year prior to the study. A sample of 581 women aged 35 years and older was used. Data were collected during in-home interviews led by graduate research assistants. Results indicated that the predisposing variables of seriousness, benefits, health motivation, control, knowledge of breast cancer and mammography guidelines, socioeconomic status, age, physician recommendation for mammography, and prior breast symptoms were significantly related to having had recent mammography.

Influence of spontaneous or induced labor on delivering the macrosomic fetus

Fetal macrosomia is a known intrapartum risk factor for fetal injury and maternal morbidity. The purpose of this study was to review our experience with macrosomic fetuses in nondiabetic pregnancies and compare perinatal outcomes between those whose labor had been spontaneous or induced. Between January 1989 and December 1991, the 186 pregnancies of infants with birthweights greater than 4000 g (4001 to 5131 g) underwent labor that had been induced (46) or spontaneous (140). Cesarean delivery was more common after induced than spontaneous labor (11 [23.9%] vs 14 [10.0%]; P < 0.03) regardless of parity or gestational age. Frequencies of shoulder dystocia, 1-minute Apgar scores less than 7, and abnormal umbilical blood gas determinations were not different between the two groups. We conclude that spontaneous rather than induced labor is associated with a lower chance of cesarean delivery among those fetuses with birthweights 4000 g or more.

Intravaginal prostaglandin E2 for cervical ripening and initiation of labor. Comparison of a multidose gel and single, controlled-release pessary

A study was conducted to compare the efficacy and safety of two methods of delivering prostaglandin E2 (PGE2) as a low-dose gel delivered in up to two sequential, 2.5-mg doses and as a single-dose, controlled-release, 10-mg pessary. A cervical change was present in both groups, but a Bishop score > or = 8 occurred in more nulliparous patients in the pessary than in the gel group by 12 hours after dosing. Labor was initiated without oxytocin more frequently in the pessary than gel group for nulliparas and multiparas. Reversal of uterine hyperstimulation was possible by removal of the pessary without tocolytic therapy. The controlled-release PGE2 pessary was more effective in changing the cervix in nulliparas and in initiating labor and offered the advantage of removal when desired.

Epidemiology for community health nursing: an interactive computer assisted instruction program

Epidemiology and its application to community health nursing is an essential concept for baccalaureate nursing students. To facilitate student learning, nursing faculty chose to use computer assisted instruction (CAI) as an adjunct teaching-learning strategy. An interdisciplinary team, including nursing content specialists and a computer programmer, produced an interactive CAI that integrated epidemiologic content, community health nursing practice, and learning-theory principles. Contents of the program modules are described, and program strategies used to enhance learning are delineated. Evaluation of the program indicated students (N = 106) believed the content was clearly explained and preferred learning epidemiology through combining classroom learning with CAI rather than through textbook reading assignments.

Health care reform: clarifying the concepts

Despite agreement about problems with the health care system, there is disagreement about the remedy. Like most health care reform debates, this article focuses on financing methods rather than service delivery. Reform strategies are intentionally oversimplified into four categories: employer-based or "play or pay"; single-payer and modifications, such as expanding Medicaid or Medicare; market competition; and managed competition, which appears to be favored by the Clinton administration. Cost-control mechanisms and insurance reforms are applicable to all four financing methods. Reform is inevitable. The challenge for nurses is to understand reform issues and then influence policymakers to initiate reforms that make essential medical and preventive services universally available.

Hematopoietic growth factors in autologous bone marrow transplantation

The availability of recombinant human hematopoietic growth factors (rhHGFs) for clinical use has the potential to significantly decrease the morbidity and cost of autologous bone marrow transplantation (ABMT) and to make this therapeutic modality available to a broader patient population. Three rhHGFs currently have Food and Drug Administration-approved indications, although only one has a specific indication for ABMT. Recombinant human granulocyte-macrophage colony-stimulating factor and granulocyte colony-stimulating factor have been used in several trials of ABMT. Recombinant human erythropoietin is less well studied to date in the setting of ABMT. Several investigational rhHGFs, including interleukin-3, -6, and -11, PIXY 321 (a granulocyte-macrophage colony-stimulating factor/interleukin-3 hybrid), and kit ligand (also known as "stem cell factor"), have the potential for affecting multiple lineages.

Recombination walking: genetic selection of clones from pooled libraries of yeast artificial chromosomes by homologous recombination

Recombination walking is based on the genetic selection of specific human clones from a yeast artificial chromosome (YAC) library by homologous recombination. The desired clone is selected from a pooled (unordered) YAC library, eliminating labor-intensive steps typically used in organizing and maintaining ordered YAC libraries. Recombination walking represents an efficient approach to library screening and is well suited for chromosome-walking approaches to the isolation of genes associated with common diseases.

Mammography in women > or = 50 years of age. Predisposing and enabling characteristics

The purpose of this study was to identify the relationship of selected predisposing and enabling characteristics of women > or = 50 years of age to mammography utilization. Andersen and Aday's theoretical model for health services utilization guided data collection. Data were collected from a convenience sample of 161 women members of four urban churches, using a mailed survey. Results showed that 81% reported at least one mammogram and 24% had followed mammography guidelines for the preceding 3 years. Results of logistic regression analyses with variables having a bivariate significance of p < or = 0.01 showed that higher income was associated with both ever having a mammogram and adherence. Willingness to pay > $50 out of pocket for a mammogram was significant for 3 year adherence. Additionally, the sociodemographic variables of age and religion were associated with adherence, whereas a college education was highly significant (odds ratio = 13.78) for ever having a mammogram. Having a regular place for health care and having yearly Papanicolaou tests were associated with ever having a mammogram, but not adherence. Finally, intending to get a mammogram was associated with ever having a mammogram. In this study, belief and knowledge variables showed no association with utilization, and social influence had bivariate significance only for ever having a mammogram. This study suggests the importance of addressing economic and health-care delivery system factors to promote increased mammography utilization, particularly for older women.